CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Valor Health

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,005
Cash Discount Price: $2,190
vs. Medicare Baseline: 18.77x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Valor Health is $2,005. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,190. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 18.77x the Medicare baseline. Located in 1202 East Locust Street, Emmett, ID.

Cash / Self-Pay

$2,190

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,005

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $2,190 (2050%)

Insurance Median: $2,005 (1877%)

Cash: $2,190 (2050% of Medicare)

Ins. Median: $2,005 (1877% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1877% of the Medicare baseline (a markup of 1777%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Tricare	$1,051	984%
Aetna	$1,084 - $1,925	1015%
Blue Cross Blue Shield	$1,084 - $2,259	1015%
Blue Shield Mcr Adv	$1,084	1015%
Humana	$1,084 - $2,259	1015%
Molina Mcr Adv - All Plans	$1,084	1015%
Regence Bs Triwest - All Plans	$1,084	1015%
UnitedHealthcare	$1,084 - $2,130	1015%
Pacificsource Mcr Adv	$1,138	1065%
Cigna	$2,084 - $2,128	1951%
Moda Health - All Plans	$2,190	2050%
Pacificsource Comm - All Other Plans	$2,190	2050%
Select Health Comm - All Other Plans	$2,190	2050%
Blue Shield Comm - All Other Plans	$6,916	6475%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $2,190.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72131.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Valor Health is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72131.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.